Brief Summary
Marci is a female college student aged 22 and is involved in alcoholism, marijuana use, and cigarette smoking. She is depressed and anxious although she has no panic attacks or suicidal thoughts. She has never been to either outpatient or inpatient treatment facilities. Marci stays with her parents and her two younger siblings. Due to Marci's substance misuse and run-ins with the law, it is evident of a strained family relationship. Five months ago, she was charged for possessing 1 g of Marijuana and driving under the influence of alcohol, with a blood level alcoholic content of 0.13. Her substance misuse problems are spilling over into other aspects of her life reducing academic performance and drop-in class attendance. Depression, anxiety, substance misuse, and family problems are the most critical concerns to address with Marci.
Current And Past Substance Use and Effects
The first substance that she abuses is alcohol. Alcohol is normally taken orally as a drink. Marci currently drinks wine and beer during school evenings and even on weekends. The effects of Alcohol abuse cannot be assumed as it disrupts communication between the brain and other body parts, leading to impaired judgment, impulse behavior, memory loss, and symptoms of intoxication (Brick, 2012). Excessive drinking cause’s cognitive impairments, characterized by interfered verbal fluency, working memory, and impulsivity because alcohol predominantly affects the normal functioning of the brain (Babor et al., 2005). Most people experience euphoria, a pleasurable feeling, as well as a reduction in anxiety when they consume alcohol. The side effects of alcohol abuse and consumption are liver disease, brain damage, and heart illnesses (Arjundas & Gilvarry, 2004). Memory loss, blackouts, alcohol poisoning, and hangovers are all severe side effects of consuming alcoholic beverages.
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The second substance that she abuses is Tobacco. Tobacco is normally smoked although at times it is sniffed as well as taken orally in form of gum. Marci has been a cigarette smoker since she was 16 and currently smokes a pack a day. Tobacco products contain nicotine which has the remarkable ability to function as a stimulant, assisting people in staying alert and focusing their attention while also promoting relaxation (Ksir & Carl L Hart, 2017). Cigarette smoking has been linked to causing lung cancer to the users and low birth weight in newborns. Smoking can also cause stroke, coronary heart disease, and cardiovascular diseases, with all the disorders having the capability to cause death. Smoking lowers fertility and can result in miscarriages or birth defects. Cigarette smoking is harmful to the general health of a person and increases the chances of developing cataracts.
The third substance that Marci has been abusing is Marijuana. Marijuana is smoked but can also be taken orally in form of cookies and cakes. She has been smoking marijuana two to three times a week, even during school evenings. In school, she has smoked half a joint every evening for the previous two months. Marijuana contains Tetra-hydro-cannabinol (THC), which is rapidly absorbed into the bloodstream within thirty minutes of consumption. It is first delivered to the brain, then to the rest of the body so that its effects can start functioning in the body. Within 5 to 10 minutes, the mood-altering and cardiovascular effects spread and reach their apex (Knopf, 2017). It could take two or three weeks for a significant dose of THC and its metabolites to be eliminated from the body. Users report feelings of euphoria, mellowness, appetite, and stimulation as subjective effects. Marijuana causes side effects such as impaired cognitive function, immunological dysfunction, anxiety and in the long term it can cause mental illnesses such as psychosis.
Risks/Dangers for Client
Drug abuse carries a number of risks, including interpersonal and job troubles, as well as psychological, physical, and financial consequences. People commonly use illicit drugs for personal medication to alleviate internal and external concerns, however this coping method causes more harm and is dangerous. Marci's excessive use of marijuana, cigarettes, and alcohol raises her chances of acquiring health problems connected with substance misuse, such as mental disease and physical degradation.
Consumption of excess alcohol can lead to health issues such as heart complications, liver damage, and deadly alcohol poisoning. While it may appear harmless fun at first, using drugs or alcohol in college can develop into addiction and dependence. Addiction is a severe medical illness that can jeopardize her academic performance, career, and vital relationships and hinder Marci's everyday school life. Besides addiction, drug abuse leads to serious social problems such as arrests, school indiscipline, and a tarnished reputation .
Marci is in the early stages of pre-contemplation. People who are in the pre-contemplation phase do not believe their behavior to be problematic. That could be due to a lack of awareness of the destructive effects of their actions, or it could be due to denial of the intensity or harmful nature of the impact they have already experienced. Drug users in this stage of addiction are generally uninterested in hearing about the adverse effects or receiving advice on quitting (Ponizovskiy, 2017). At this point, they frequently perceive their addicted behavior as a pleasurable experience. Negative consequences do, however, finally affect them, and the matter gets out of control. These unfavorable outcomes can lead to contemplation in the individual.
AUDIT scores and Explanation
The WHO developed the AUDIT questionnaire as a simple technique for screening excess drinking and assisting in making a quick assessment. It creates a framework for intervention to help hazardous drinkers stop or reduce their alcohol consumption and, therefore, evade the adverse effects of their behavior. The AUDIT also aids in the detection of alcoholism and some of the negative repercussions of alcohol drinking.
The first question on the questionnaire enquires how often the client consumes drinks containing alcohol. I assigned a score of 4 to Marci because she drinks four or more times each week. The second question is about how often the client consume drinks containing alcohol on a typical drinking day. For this question, I gave a score of 0; according to the grading method, a 0 score is allocated for 1-2 drinks a day. Marci acknowledged having had 1-2 glasses of wine for the past two months. The third question enquired to establish how often the client takes more than six drinks on a single drinking occasion. I allocated a three-point rating for her weekly drinking. According to the facts presented in the case study, Marci presently drinks three to four times per week per week. Her overall score for the first three questions was a 7, indicating that she was actively involved in dangerous drinking, as a score of 5 or more indicates hazardous and hazardous drinking.
The fourth AUDIT question enquired how often in past one year the client discovered she was unable to stop drinking. I gave a score of 4 after Marci stating that she consumes alcohol daily. The fifth question is on how often during the previous year the client failed to do duties due to her drinking. Marci's testimony about her class attendance, drop in grades, quite often accidents, repeated loss of gained employment, and legal troubles resulted in a score of 4, which represented daily or practically daily. Marci was fired many times for absenteeism and property damage, low-class attendance, grades plummeting to the point where her parents threatened to notify the academic dean. The arrests that occurred were all factors that contributed to her score.
The sixth question is based on how often, in the last one year the client had to take an alcoholic drink in the morning after a heavy drinking session. This question received a score of 0. The score was given because I could not locate any evidence that Marci had such an encounter in this case study. The seventh question attempts to establish how often the client has been feeling guilty after drinking. I allocated a score of one. This score of 1 showed that it was less than once a month. I included this score because it appeared from the case study that Marci’s regret and or guilt popped up at the point of interaction with Family and close relatives, but when she was on her own, she continued to drink.
The eighth question is based on how often the client was unable to recall events of the previous night due to drinking. I gave this question a score of Zero. The number 0 represents never. I find it correct because I could not discover any evidence that this was anything Marci had encountered in the case study. The ninth question attempts to establish whether the client or someone else has been injured due to the client's drinking. I allocated a score of 4 for this question. This score is backed up by material from the case study, which notes that while Marci did not strike her head while drunk, she did suffer a few knocks and bruises. The final question attempts to establish whether a friend, doctor or health worker has been concerned about the clients drinking and offered suggestions to cut down. I gave a score of 4 as it happened during the last year. This score is backed up by Marci's parents, who are seeking treatment for her drug/alcohol abuse, as well as her siblings, who her drinking habits have also harmed.
Following my assessment of the Case Study, Marci received a total score of 24 out of 40 on the AUDIT questionnaire. AUDIT scores of 20 or higher should be followed up with a diagnostic examination for alcoholism (Babor et al., 2001). These patients ought to be referred to a specialist for an alcohol dependency diagnosis and appropriate treatment.
Recommendations/Referrals/Resources
Marci should be referred to a specialist for an alcohol dependency diagnosis and appropriate treatment. Primary care management through mutual help organizations at the basic community level is paramount. The patient can be handled at the most basic degree of intervention permitted by their AUDIT score using a stepped-care strategy. The following are some of the critical programs I would like to recommend for Marci and her Family.
The first recommendation is to enroll in a 12-step recovery program. The 12-Step program's primary purpose is to provide those battling with addiction with a mechanism for understanding and managing drug use anomalies and psychosocial support for recovery from others who are going through similar challenges. 12-Step programs can help people restructure their thinking about substance misuse and other habits. This program allows people to alter their substance misuse behavior patterns (American Addiction Center, 2020). Marci would benefit from the 12-step program since her Family can be included, the program consists of spiritual components, and primarily women and persons of elderly age are more likely to participate and benefit from these groupings.
The second recommendation is the Family close Interaction Program, which would be beneficial to improve the strained family relationship, owing to Marci's struggles with drug abuse and the parents' prolonged drug and alcohol usage. The family close interaction program encourages families to investigate, brainstorm, and focus on alcohol and drug use-related issues as a unit (Banerjee, 2017). That would be beneficial in helping Marci and her Family at large on how to rebuild their family relationships and avoid the negative impacts of alcohol consumption.
Another program to recommend is the Inpatient Treatment program. Marci could benefit from this program since she would receive a comprehensive medical and psychosocial exam during the intake process. That will aid in a proper assessment of the depression and anxiety difficulties she has previously experienced. Treatments such as the Detox and other remedies through the withdrawal period are highly beneficial to the clients under this kind of program (El-Guebaly et al., 2020). Marci’s residence will be in a quiet, secure setting, free from potential situational or environmental active triggers that might exacerbate her addiction. In addition, family therapy and skills training will be provided in inpatient residential care to ensure that an outgoing patient has a highly supportive environment possible as he or she exits treatment.
The final recommendation is the Twin-Diagnosis Treatment program which treats psychiatric health and addiction as a continuum, rather than creating a rigid boundary between the two. When a patient has co-occurring problems, such as a mental health problem and alcohol or drug addiction, dual diagnosis treatment is essential. Without realizing it, most addicts may be suffering from diseases such as depression, bipolar, anxiety, or personality disorders. The absence of treatment for one ailment can increase the other over time. Patients benefit from a comprehensive dual diagnosis treatment program because it provides them with the skills they need to make a long-term recovery. Patients will know what they are dealing with when sadness, anxiety, or panic attacks strike, for example. Counselors or therapists may give patients skills and recommendations to deal with these psychological and psychosocial side effects, which can minimize the burning desire for drug or alcohol usage (Banerjee, 2017). Marci might gain from this mode of treatment because of the depression and anxiety issues she had within the case study and the alcohol and substance abuse.
Questions
I would like to ask Marci some of these questions, as they were not adequately provided in the case study narrative .
• How have you managed to stay off Marijuana after your last accident?
• What in particular do you consider to be your strengths?
• How often do you experience anxiety and depression? (Daily, fortnightly, weekly, monthly)
• Do you want to give up or reduce your alcohol and marijuana consumption?
References
American Addiction Center. (2020, May 19). 12 step programs for drug rehab & alcohol treatment . American Addiction Centers. Retrieved June 4, 2021, from https://americanaddictioncenters.org/rehab-guide/12-step
Arjundas, R., & Gilvarry, E. (2004). Drug and alcohol abuse. Cognitive Behaviour Therapy for Children and Families , 459-478. https://doi.org/10.1017/cbo9780511543845.026
Babor, T. E., Higgins-Biddle, J., Dauser, D., Higgins, P., & Burleson, J. A. (2005). Alcohol screening and brief intervention in primary care settings: Implementation models and predictors (Vol. 66). https://doi.org/10.15288/jsa.2005.66.361
Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT, The Alcohol Use Disorders Identification Test (2nd ed.). WHO.
Banerjee, B. (2017). Drug de-addiction programme. DK Taneja’s Health Policies and Programmes in India , 483-483. https://doi.org/10.5005/jp/books/13071_38
Brick, J. (2012). Handbook of the medical consequences of alcohol and drug abuse . Routledge.
El-Guebaly, N., Carrà, G., Galanter, M., & Baldacchino, A. M. (2020). Textbook of addiction treatment: International perspectives . Springer Nature.
Knopf, A. (2017). Adolescent exposure to marijuana linked to adverse effects in adulthood. Alcoholism & Drug Abuse Weekly , 29 (12), 1-3. https://doi.org/10.1002/adaw.30887
Ksir, C. J., & Carl L Hart, D. (2017). Drugs, society, and human behavior . McGraw-Hill Education.
Ponizovskiy, P. (2017). Cognitive status and addiction denial in the early stages of alcohol addiction. https://doi.org/10.26226/morressier.5885d718d462b8028d890e7f
